Provider Demographics
NPI:1427152669
Name:TUCKER, DAVID JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE. 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-273-0195
Mailing Address - Fax:314-273-0190
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E
Practice Address - Street 2:STE 280
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1350
Practice Address - Country:US
Practice Address - Phone:314-273-0195
Practice Address - Fax:314-273-0190
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7D56207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00637979OtherRR MEDICARE
MO110229356OtherRR MEDICARE
A25398Medicare UPIN
MOP00637979OtherRR MEDICARE
MO953104799Medicare PIN